CSF Rhinorrhoea After Endonasal Intervention to the Skull Base (CRANIAL) - Part 1: Multicenter Pilot Study

, Danyal Z. Khan, Hani J. Marcus (Lead / Corresponding author), Hugo Layard Horsfall, Soham Bandyopadhyay, Benjamin E. Schroeder, Vikesh Patel, Alice O'Donnell, Shahzada Ahmed, Andrew F. Alalade, Ahmad M.S. Ali, Callum Allison, Sinan Al-Barazi, Rafid Al-Mahfoudh, Meriem Amarouche, Anuj Bahl, David Bennett, Raj Bhalla, Pragnesh Bhatt, Alexandros BoukasIvan Cabrilo, Annabel Chadwick, Yasir A. Chowdhury, David Choi, Simon A. Cudlip, Neil Donnelly, Neil L. Dorward, Graham Dow, Daniel M. Fountain, Joan Grieve, Anastasios Giamouriadis, Catherine Gilkes, Kanna Gnanalingham, Jane Halliday, Brendan Hanna, Caroline Hayhurst, Jonathan Hempenstall, Duncan Henderson, Kismet Hossain-Ibrahim, Theodore Hirst, Mark Hughes, Mohsen Javadpour, Alistair Jenkins, Mahmoud Kamel, Richard J. Mannion, Angelos G. Kolias, Habibullah Khan, Mohammad Saud Khan, Peter Lacy, Daniel Murray, Paresh P. Naik, Ramesh Nair, Claire Nicholson, Alex Paluzzi, Omar Pathmanaban, Dimitris Paraskevopoulos, Jonathan Pollock, Nick Phillips, Rory J. Piper, Bhaskar Ram, Iain Robertson, Elena Roman, Peter Ross, Thomas Santarius, Parag Sayal, Jonathan Shapey, Rishi Sharma, Simon Shaw, Alireza Shoakazemi, Syed Shumon, Saurabh Sinha, Georgios Solomou, Wai Cheong Soon, Simon Stapleton, Patrick Statham, Benjamin Stew, Nick Thomas, Georgios Tsermoulas, James R. Tysome, Adithya Varma, Philip Weir, Adam Williams, Mohamed Youssef

Research output: Contribution to journalArticlepeer-review

18 Citations (Scopus)
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Background: CRANIAL (CSF Rhinorrhoea After Endonasal Intervention to the Skull Base) is a prospective multicenter observational study seeking to determine 1) the scope of skull base repair methods used and 2) corresponding rates of postoperative cerebrospinal fluid (CSF) rhinorrhea in the endonasal transsphenoidal approach (TSA) and the expanded endonasal approach (EEA) for skull base tumors. We sought to pilot the project, assessing the feasibility and acceptability by gathering preliminary data.

Methods: A prospective observational cohort study was piloted at 12 tertiary neurosurgical units in the United Kingdom. Feedback regarding project positives and challenges were qualitatively analyzed.

Results: A total of 187 cases were included: 159 TSA (85%) and 28 EEA (15%). The most common diseases included pituitary adenomas (n = 142/187), craniopharyngiomas (n = 13/187). and skull base meningiomas (n = 4/187). The most common skull base repair techniques used were tissue glues (n = 132/187, most commonly Tisseel), grafts (n = 94/187, most commonly fat autograft or Spongostan) and vascularized flaps (n = 51/187, most commonly nasoseptal). These repairs were most frequently supported by nasal packs (n = 125/187) and lumbar drains (n = 20/187). Biochemically confirmed CSF rhinorrhea occurred in 6/159 patients undergoing TSA (3.8%) and 2/28 patients undergoing EEA (7.1%). Four patients undergoing TSA (2.5%) and 2 patients undergoing EEA (7.1%) required operative management for CSF rhinorrhea (CSF diversion or direct repair). Qualitative feedback was largely positive (themes included user-friendly and efficient data collection and strong support from senior team members), demonstrating acceptability.

Conclusions: Our pilot experience highlights the acceptability and feasibility of CRANIAL. There is a precedent for multicenter dissemination of this project, to establish a benchmark of contemporary practice in skull base neurosurgery, particularly with respect to patients undergoing EEA.

Original languageEnglish
Pages (from-to)e1077-e1089
Number of pages13
JournalWorld Neurosurgery
Early online date11 Jan 2021
Publication statusPublished - May 2021


  • Cerebrospinal fluid leak
  • Cerebrospinal fluid rhinorrhea
  • CSF
  • EEA
  • Endoscopic endonasal
  • Skull base surgery

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology


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